Arizona Department of Health Services *report to adhs within 24 hours mumps-Quick Sheet Infectious agent



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Arizona Department of Health Services
*REPORT TO ADHS WITHIN 24 HOURS*

Mumps-Quick Sheet
Infectious agent: The mumps virus is a paramyxovirus in the same group as influenza.

Mode of transmission: Direct or droplet contact with respiratory secretions of an infected person

Period of Communicability: The infectious period is considered to be from 6-7 days before parotitis onset to 9 days after parotitis onset.
CDC Case Definition and Classification (for purposes of public health reporting)

Clinical Case Definition


An illness lasting 2 or more days, with:

 acute onset of swelling of the parotid or salivary glands, AND

 without any other apparent cause (as reported by a physician)

Laboratory Criteria for Diagnosis


 Isolation of mumps virus from a clinical specimen (nasopharyngeal swab or urine)

 A significant rise between acute- and convalescent-phase titers in serum mumps immunoglobulin G (IgG) antibody level by standard serologic assay.

Positive serological test for mumps IgM antibody.

Specimens to Collect (forward all specimens to Arizona State Laboratory)


Acute and convalescent sera (collect acute serum ASAP after parotitis onset and no later than 7 days post parotitis onset. Collect convalescent serum >=3 WEEKS after acute serum was collected)

Nasopharyngeal swab in Hank’s solution (collect ASAP and no later than 5 days from the onset of parotitis) – See “Instructions for Collecting Nasopharyngeal Swab Specimens”).

Urine Specimen (collect ASAP and no later than 14 days from the onset of parotitis)

Case Classification


Confirmed: a case that is laboratory confirmed or meets the clinical case definition and is epidemiologically linked to a confirmed case.

Probable: meets the clinical case definition but has no or noncontributory serologic or virologic testing, and is not epidemiologically linked to a confirmed case.



Clinical Features



Subclinical Infection

Up to 20% of persons infected with mumps are asymptomatic. An additional 40%-50% may have only non-specific or mild respiratory symptoms.



Incubation period

Twelve to 25 days, commonly 18 days, post exposure.



Prodrome

Prodromal symptoms are nonspecific and include myalgia, anorexia, malaise, headache and low-grade fever.



Parotitis

A swelling of the parotid glands, may be noted as earache, tenderness on touching the angle of the jaw, occurring 1-2 days after prodrome. Unilateral or bilateral, affecting any combination or single or multiple salivary glands, occurs in 30-40% of infected persons. Symptoms tend to decrease after one week, and are usually gone by 10 days.



Recommended Treatment and Chemoprophylaxis

Treatment of mumps is supportive. Although mumps vaccine is not thought to be effective in preventing infection of exposed persons, it can be given, as immunization will protect against subsequent exposure.


Mumps Immunity
Acceptable evidence of mumps immunity is determined by meeting one of the following criteria:

1. Documentation of having received one dose of live virus mumps vaccine on or after 12 months of age. 2. Serological evidence of mumps antibodies.

3. Born before 1957.

Mumps Investigation

Mumps is a reportable disease, and County or Local Health Departments must be notified within 24 hours when a case is suspected. A Communicable Disease Reporting Form and a Mumps Surveillance Worksheet must be submitted for each confirmed mumps case. Reporting of communicable disease is mandated under the Arizona Administrative Codes (R9-6-339).


Case Investigation process:

1. Upon notification of a suspected mumps case, interview the patient to collect the following information:

 demographic information (name, age, address, and other pertinent demographic information)

 information regarding clinical signs and symptoms

 pertinent medical information (physician information, hospitalization, etc.)

 information regarding patient’s immune status (history of mumps vaccination)

 information regarding the possible source of exposure.

Examples:

 contact with a person who is suspected of having mumps disease

 travel or gathering

medical facility

 a list of all household and other close contacts, noting those who do not have immunity

Collect laboratory specimens (see “Specimens to Collect” section) and forward to the Arizona State Laboratory for mumps testing


  1. Exclude suspected case from school/work settings for 9 days


The following time line depicts the clinical course of mumps and may be useful in an investigation

Exposure and Incubation Period (14-25 days)

Weeks: -3 -2 -1


Parotitis (~7 days)

ONSET

Communicability

7-10 days

Onset of Parotitis minus 18 days is probable exposure

DATE:

Prodrome: low-grade fever, (non-specific) myalgia, anorexia, malaise, and headache
Onset of parotitis minus 6-7 days is probable start of infectious period.

DATE:

1-2 days after prodrome; occurs in 30-40% of cases

DATE:

Onset of parotitis plus 9 days is probable end of infectious period.

DATE:



Mumps Outbreak Control Strategy: Schools (Pre-K through College)
The following course of action is recommended to prevent the spread of mumps disease:
 Exclude case for 9 days after the onset of parotid swelling.

 Consider excluding known or presumed susceptibles born in 1957 or later for twenty-five days after parotitis onset in the last person diagnosed with mumps in the outbreak setting.

 Conduct surveillance of contacts for two incubation periods (50 days) from most recent exposure, collect laboratory specimens from symptomatic contacts and forward to Arizona State Laboratory for mumps testing

 Immunize all susceptibles greater than or equal to 12 months of age



 Excluded persons who are asymptomatic can be readmitted immediately after vaccination.


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